Atrophic vaginitis

Atrophic vaginitis is an inflammation of the vagina due to thinning and shrinking tissues and decreased lubrication of the vaginal walls. It is caused by a lack of estrogen.

Causes, incidence, and risk factors
Atrophic vaginitis is typically caused by a decrease in estrogen, as normally occurs after menopause. The disorder may occur in younger women who have had surgery to remove their ovaries. Some women experience it immediately after childbirth or while Breastfeeding, since estrogen levels are lower at these times.


  • Vaginal soreness - may be an itching or burning sensation.  
  • Slight vaginal discharge.  
  • Burning on urination.  
  • Light bleeding after intercourse.  
  • Painful sexual intercourse.

Signs and tests
A pelvic examination reveals thin, pale vaginal walls. A wet prep (microscopic evaluation of vaginal discharge) may be done to rule out other causes of vaginitis. Hormonal studies may be done if menopausal status is uncertain.

Topical estrogen creams or tablets may be used vaginally. Alternatively, oral or transdermal estrogen replacement therapy may be initiated. Usually, this is effective in overcoming the problem. Women may want to discuss the risks and benefits of oral estrogen replacement therapy with their physicians.

Painful sexual intercourse may be helped by using a water-soluble vaginal lubricant.

Expectations (prognosis)
Proper treatment will usually relieve the symptoms.


  • Atrophic vaginitis may predispose a woman to having vaginal infections caused by bacteria or fungi (yeast). However, usually there is not a specific infection. Instead, there is a localized skin reaction to the normal bacteria found there.  
  • The condition can cause open sores or cracks in the vaginal wall.

Calling your health care provider
Call for an appointment with your health care provider if you are experiencing vaginal dryness or soreness, burning, itching, or painful sexual intercourse that is not alleviated with a water-soluble lubricant.

For post-menopausal women in particular, regular sexual activity, with or without a partner, is recommended. Sexual activity improves blood circulation in the vagina, which helps maintain the tissue.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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